P1569: HERPES ZOSTER VACCINATION IN HEMATOLOGY. A SINGLE CENTER EXPERIENCE.
Authors: Natalia De Las Heras Rodriguez, Fernando Escalante, Laura Gomez del Campo, María Jesús Vidal
Journal: HemaSphere (2023)

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: Herpes zoster (HZ) is caused by the reactivation of the latent varicella zoster virus (VZV) due to ageing (immunosenescence) or immunosuppression. In immunocompromised (IC) there is a greater risk of HZ. Since 2021 Public Health Authorities in Spain endorsed HZ vaccination for adults 18+YOA with at-increased risk conditions including Hematopoietic stem cell transplantation (HSCT), treatment with JAKi and haematological malignancies. Following clinical trials experience from Zoster 002 and Zoster 039 vaccination is recommended in patients with malignant blood diseases on Watch and Wait (W&W), on treatment with chemotherapy or other therapies with a risk of immunosuppression or who received immunosuppressive therapy in the past.. Aims: To describe our initial experience with the Shingrix vaccine in haematological patients. Methods: We analysed 83 patients vaccinated in our Service. Thirty-seven (37) of the patients were women and 46 were men. Of these 83 patients, 13 were vaccinated in an early post-autologous transplantation setting, 2-3 months after the infusion of haematopoietic stem cells. Ten (10) patients had had a previous herpes zoster and the closest interval between infection and vaccination was 1 month. Twenty-five patients (25) received concomitant aciclovir which was not suspended after vaccination. Forty (40) of the 83 patients were on active treatment at the time of vaccination (including patients with post-transplant consolidation or maintenance), and only 4 patients were vaccinated just before they began the haematological treatment (2 with chemotherapy and 1 with ruxolitinib), 17 patients were vaccinated on completion of their haematological treatment and 22 patients received no treatment or no treatment was scheduled to be initiated at the time of vaccination. Of the 13 patients that underwent an autologous transplantation, 5 were on maintenance treatment with lenalidomide, 5 were on consolidation treatment with Daratumumab, velcade, thalidomide and dexamethasone (DVTD), and 3 were not on any treatment.. Results: We evaluated the safety profile in the patients that were given the Shingrix vaccine, observing that it presents a clinically acceptable profile in our immunocompromised populations ≥18 years. The local adverse events reported were minimal (4 patients with pain at the administration site, 6 patients with erythema and 3 patients with swelling). No systemic adverse events such as fever, nausea or vomiting were observed. All the patients except for one woman received both doses of the vaccine, or in other words the 2-dose schedule presented a 90% compliance rate. Two patients reprted HZ after vaccination, mild and without complications. The interval between doses was 2 months (±7 days). Shingrix can be given concomitantly with the inactivated non-adjuvanted flu vaccine, the 13 and 23-valent pneumococcal vaccine and the Tdap vaccine. In the transplantation patients, we began the vaccination schedule after 3 months, together with the pneumococcal (13-valent) vaccine, although we decided to administer them separately for the moment in order to assess any adverse effects, which did not emerge.. Summary/Conclusion: Shingrix is safe and well tolerated both in patients with malignant blood diseases with or without chemotherapy and in patients in the early post-autologous transplantation period. Although the number of patients with post-vaccine HZ was very small, we observed that infection was much milder, lasted less and was devoid of subsequent complications. Keywords: Infection, Vaccination, Herpesvirus